medigraphic.com
ISSN 2992-7749 (Electronic)
ISSN 2992-7897 (Print)
Órgano Oficial de difusión científica de la Asociación Mexicana de Cirujanos de Columna A. C.

2025, Number 4

<< Back Next >>

Cir Columna 2025; 3 (4)

Rare presentation of extraforaminal abscess. Case report

Díaz OO, Dittmar JM, Cruz LF, Rodríguez LA, Navarro AD

Language: Spanish
References: 22
Page: 311-317
PDF size: 731.77 Kb.


ABSTRACT

Introduction: disc herniation is a common pathology worldwide, the majority occurs at the level of the cervical and lumbar spine and its location is generally in the spinal canal, with few cases with extraforaminal location. Extraforaminal disc herniation is a condition that is easily confused with an abscess or a tumor. Spondylodiscitis is an infection of the intervertebral disc, the adjacent vertebral body and/or adjacent structures due to the introduction of an infectious agent, usually through the hematogenous route. The distinction between inflammatory/degenerative versus infectious pathology has a great prognostic impact. Case report: a 62-year-old male patient suffers from hypertension and has a history of lumbar spine surgery in 2014. It began in May 2024 with sudden pain in the right gluteal region (Visual Analogue Sale) VAS 10/10, radiating through the back of the thigh and numbness in the anterior and lateral tibial area, secondary to jumping from a high bench. Magnetic Resonance Imaging (MRI) of the lumbar spine was requested where a right L4-L5 extraforaminal disc herniation was found. It was scheduled for foraminal infiltration, however, there was no improvement, so surgery was proposed to extract the extraforaminal fragment, finding a herniated disc and an extraforaminal abscess, a sample was taken for culture, surgical washout was made and antibiotics were administered according to the antibiogram. Conclusions: the patient has had a good clinical evolution, in the last review appointment he mentions improvement in symptoms although pain in the buttock persists, he spent 45 days with an antibiotic therapy regimen with daptomycin and ceftriaxone, followed by 2 months of trimethoprim/sulfamethoxazole and doxycycline.


REFERENCES

  1. Parmar G, Soin P, Sharma P, French C, Han B, Kochar PS. Sequestered disc herniation mimicking psoas abscess: a rare case report. Radiol Case Rep. 2022; 17: 223-226.

  2. Kabeer AS, Osmani HT, Patel J, Robinson P, Ahmed N. The adult with low back pain: causes, diagnosis, imaging features and management. Br J Hosp Med. 2023; 84: 1-9.

  3. Polak SB, Madsbu MA, Vangen-Lonne V, Salvesen O, Nygaard O, Solberg TK, et al. Surgery for extraforaminal lumbar disc herniation: a single center comparative observational study. Acta Neurochir (Wien). 2020; 162: 1409-1415.

  4. Piccolo CL, Villanacci A, Di Stefano F, Fusco N, Donno DR, Cristofaro M, et al. Spondylodiscitis and its mimickers: a pictorial review. Biomedicines. 2024; 12: 2566.

  5. Roy M, Ahmad S, Roy AK. Rare presentation of vertebral discitis, osteomyelitis and polyarticular septic arthritis due to disseminated Neisseria gonorrhea infection. J Community Hosp Intern Med Perspect. 2020; 10: 55-59.

  6. Azizi L, Jaber R, Faddoul S. Psoas muscle sequestered disc mimicking an intramuscular abscess: a rare case report. Radiol Case Rep. 2024; 19: 4622-4626.

  7. Katsevman GA, Emery E, France JC, Sedney CL. Secondary discitis masquerading as treatment failure of primary discitis: case report and review of the literature. Int J Spine Surg. 2019; 13: 120-124.

  8. Salaffi F, Ceccarelli L, Carotti M, Di Carlo M, Polonara G, Facchini G, et al. Differentiation between infectious spondylodiscitis versus inflammatory or degenerative spinal changes: How can magnetic resonance imaging help the clinician? Radiol Med. 2021; 126: 843-859.

  9. Rambo WM. Treatment of lumbar discitis using silicon nitride spinal spacers: a case series and literature review. Int J Surg Case Rep. 2018; 43: 61-68.

  10. Heyde CE, Spiegl UJA, Voelker A, von der Hoeh N, Henkelmann J. Imaging in the diagnosis of nonspecific pyogenic spondylodiskitis. J Neurol Surg A Cent Eur Neurosurg. 2023; 84: 69-76. Disponible en: http://www.thieme-connect.de/DOI/DOI?10.1055/s-0040-1709168

  11. Baryeh K, Anazor F, Iyer S, Rajagopal T. Spondylodiscitis in adults: diagnosis and management. Br J Hosp Med. 2022; 83: 1-9.

  12. Ahsan K, Hasan S, Khan S, Zaman N, Almasri S, Ahmed N, et al. Conservative versus operative management of postoperative lumbar discitis. J Craniovertebr Junction Spine. 2020; 11: 198.

  13. Uy BR, Sun MZ, Muftuoglu Y, Cheng M, Kim WJ, Magaki S, et al. Upper lumbar spine far lateral disc herniations masquerading as peripheral nerve sheath tumors: illustrative cases. J Neurosurg Case Lessons. 2023; 5: CASE22552.

  14. Crombé A, Fadli D, Clinca R, Reverchon G, Cevolani L, Girolami M, et al. Imaging of spondylodiscitis: a comprehensive updated review—multimodality imaging findings, differential diagnosis, and specific microorganisms detection. microorganisms. 2024; 12: 893. Disponible en: https://www.mdpi.com/2076-2607/12/5/893

  15. Herren C, Jung N, Pishnamaz M, Breuninger M, Siewe J, Sobottke R. Spondylodiscitis: diagnosis and treatment options. Dtsch Arztebl Int. 2017; 114: 875-882.

  16. Kramer A, Thavarajasingam SG, Neuhoff J, Ponniah HS, Ramsay DSC, Demetriades AK, et al. Epidemiological trends of pyogenic spondylodiscitis in Germany: an EANS Spine Section Study. Sci Rep. 2023; 13: 20225. Disponible en: https://www.nature.com/articles/s41598-023-47341-z

  17. Thavarajasingam SG, Vemulapalli KV, Vishnu KS, Ponniah HS, Vogel ASM, Vardanyan R, et al. Conservative versus early surgical treatment in the management of pyogenic spondylodiscitis: a systematic review and meta-analysis. Sci Rep. 2023; 13: 15647. Disponible en: https://www.nature.com/articles/s41598-023-41381-1

  18. Duplan P, Memon MB, Choudhry H, Patterson J. A rare case of Candida parapsilosis lumbar discitis with osteomyelitis. Cureus. 2022; 14: e25955.

  19. Aljawadi A, Jahangir N, Jeelani A, Ferguson Z, Niazi N, Arnall F, et al. Management of pyogenic spinal infection, review of literature. J Orthop. 2019; 16: 508-512. Disponible en: https://linkinghub.elsevier.com/retrieve/pii/S0972978X19304027

  20. Chen CT, Wu MH, Huang TY, Li YY, Huang TJ, Lee CY, et al. Anaerobic spondylodiscitis: a retrospective analysis. BMC Musculoskelet Disord. 2022; 23: 788. Disponible en: https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-022-05749-0

  21. Kim WJ, Park C, Sarraf K. Management of vertebral osteomyelitis in adults. Br J Hosp Med. 2023; 84: 1-5. Disponible en: http://www.magonlinelibrary.com/doi/10.12968/hmed.2022.0362

  22. Sato K, Yamada K, Yokosuka K, Yoshida T, Goto M, Matsubara T, et al. Pyogenic spondylitis: clinical features, diagnosis and treatment. Kurume Med J. 2018; 65: 83-89. Disponible en: https://www.jstage.jst.go.jp/article/kurumemedj/65/3/65_MS653001/_article




2020     |     www.medigraphic.com